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Out-of-Network Charges Can Break the Bank

A recent report from America's Health Insurance Plans (AHIP) shows that across the US, some physicians are charging patients fees that are 10 times, and in some cases as much as 100 times, the amount Medicare pays when patients go outside their health plan's network. In Tennessee, for the selected procedures, out-of-network charges range from 7 times what Medicare pays to 33 times what Medicare pays.

Hospitals have adopted a similar strategy. A study reported in the June edition of Health Affairs found that the 50 hospitals with highest prices charged, on average, 10 times the Medicare allowed amount. A CMS study released June 1 found a similar pattern with hospitals charging, on average, $54,000 for a major joint replacement compared to Medicare's average payment of less than $15,000. Read the NY Times article here.

There is increasing pressure on health care providers from both the public and private sectors to re-examine these policies and to get charges more in line with Medicare payments.

Posted by Cristie Travis at 9:00 AM

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